Senate Passes Prescription, Healthcare Affordability Measures

Step Therapy Reform: S1267, sponsored by Senator Neil Breslin requires a utilization review agent to follow certain rules when establishing a step therapy protocol. For example, the bill honors step therapy exceptions for 12 months after the date of the approval or renewal of the plan. It prohibits plans from requiring a patient to step through a drug that it’s being used off-label for that patient. It also prevents plans from requiring a patient to try and fail more than one drug before providing coverage for the originally prescribed medication.

Exceptions for Nonresident Pharmacies Registration Requirements: S982, sponsored by Senator Samra Brouk would permit unregistered pharmacies from outside New York to ship, mail, or deliver prescription drugs to pharmacies in-state in cases of a specific patient need or a declared public health emergency.

Program Eligibility for Plans Comparable to Medicare: S966, sponsored by Senator Gustavo Rivera, would allow individuals who have comparable coverage to a Medicare Part D plan to also be eligible for Elderly Pharmaceutical Insurance coverage (EPIC) if they otherwise qualify.

Insulin Cost Cap: S504, sponsored by Senator Gustavo Rivera, would lower the current cap on cost sharing for insulin from $100 per insulin prescription per month to $30 per month for all insulin drug prescriptions in a given month.

Notification for Prescription Drug Changes: S599, sponsored by Senator Julia Salazar, would require prescription drug manufacturers to provide at least 60-day notice of their intent to raise wholesale prescription drug costs to the Department of Financial Services if the increase is 10 percent or more of the total cost of the drug.

Prohibiting the Price Gouging of Medicine: S608A, sponsored by Senator Julia Salazar bars price gouging for drugs subject to a shortage and holds any party in the chain of distribution for charging an excessive price liable for civil penalties.

Wholesale Prescription Drug Importation: S604, sponsored by Senator James Skoufis, establishes a wholesale prescription drug importation program in New York State, in accordance with federal law, from countries with consumer safety on par with the U.S. drug supply chain system and where significant consumer cost savings are possible.

Senate Deputy Leader Michael Gianaris said, “Whether salacious crimes ripped from the headlines or frauds perpetrated on a daily basis against our seniors, financial scams are all too prevalent. New Yorkers deserve the strongest protections against these predators and my legislation would present a strong defense to keep consumers and their wallets safe. I am pleased the Senate is passing this bill.”

Bill Sponsor Senator Neil Breslin said, “It is vitally important that we ensure that the cost of prescription drugs in no way affects the ability of a patient to receive the care he or she needs.  This package of bills the Senate Democratic Conference has put forth will reduce the costs of prescription drugs while at the same time putting the patient first.”

Bill Sponsor Senator Samra Brouk said, “New Yorkers deserve to access crucial medications whenever they need them.  I’m proud that my legislation to make it easier for pharmacies to receive medications from out-of-state pharmacies has passed the Senate again, and I look forward to this legislation being signed into law. We must ensure that all people, regardless of their income or the reason, can access the quality care they deserve.”

Bill Sponsor Senator Gustavo Rivera said, “I am proud that the Senate Majority is taking immediate legislative action to alleviate the financial squeeze many New Yorkers are facing, particularly when it comes to affordable prescriptions. Two of my bills in this package will make prescription drugs more affordable by expanding EPIC coverage to more seniors and further capping the cost of insulin, a life-saving medication. New Yorkers should not need to ration insulin to make ends meet or choose between necessary medicine and rent.”

Bill Sponsor Senator Julia Salazar said, “New Yorkers should not have to shoulder an unreasonable financial burden simply to afford the costs of essential prescription drugs, which are often subject to extreme price hikes with little to no warning. Our bill, S599, would require drug manufacturers to provide notice of their intent to raise prescription costs by 10% or more. It’s time to demand transparency from pharmaceutical companies who continue to prioritize profit over the accessibility of often life-saving prescription medications.”

Bill Sponsor Senator James Skoufis said, “I am grateful to my Senate colleagues for once again sticking up for New York's families. Our prescription drug package will save residents hundreds of dollars and numerous headaches each year, making it easier for them to access important therapeutics without padding the pockets of big pharma.”

Beth Finkel, AARP New York State Director said, “Importing safe prescription drugs from Canada at much lower prices, requiring big drug makers to publicly disclose proposed price hikes ahead of time, capping out-of-pocket costs for insulin at $30 a month for New Yorkers, and allowing more seniors to benefit from the EPIC program are all common-sense, pro-consumer proposals, and AARP New York wholeheartedly supports them. For similar reasons, we also support Senator Kavanagh’s bill to give consumers powerful tools to fight unfair foreclosures.”

Ashira Vantrees of the Aimed Alliance said, “The Aimed Alliance thanks Senator Breslin for his sponsorship and applauds the Senate for acting on common sense legislation that would provide strong patient protections for insurance plans to follow when establishing step therapy protocols. These commonsense protections will ensure New Yorkers receive their appropriate treatments in a timely manner. Step Therapy, also known as “fail first '' protocols, requires insured individuals to try and fail on alternative treatments, before the plan will cover their originally prescribed treatment. This may cause adverse health effects, progression of irreversible diseases, and other complications. The guardrails in this legislation can help limit these patient impacts and ensure step-therapy protocols are used reasonably.”

Monica Billger, Director of State Government Affairs for the American Diabetes Association said, “The American Diabetes Association applauds Chairman Rivera’s critical legislation to limit insulin cost sharing to $30 per calendar month. One in six insulin-dependent people living with diabetes are forced to ration their insulin. Every day someone is faced with the unconscionable decision of purchasing life-saving medication or prioritizing other basic life necessities like food, utilities or housing. People shouldn’t be at risk for dying because they cannot afford their medication."

Heather Ferrarese PharmD, The Pharmacists Society of the State of New York (PSSNY) President said, “The Pharmacists Society of the State of New York appreciates the Senate moving quickly on this important patient medication issue in the wake of the Governor’s veto.  Pharmacists, like their counterparts in other states, need access to every tool to provide the best patient care and ensure access to medication.  Whether it be COVID, influenzas, RSV, or medication for women’s reproductive services this bill ensures pharmacists have every tool available. We applaud Senator Brouk for moving quickly, and thank Majority Leader Stewart-Cousins for her Leadership on this issue.”